Application for Employment

Application for Employment

The following information is requested in order to help us make the best possible placement within the company. All portions of this application pertaining to you must be completed. We appreciate the time you send in filling out this application form. The company , in accordance with local, state and federal laws, does not discriminate on the basis of age, race, religion, color, sex, national origin, marital status, sexual orientation, disability, status with regard to public assistance, or any other protected classification.

Personal Information

Last Name(required)

First name(required)

Middle Name(required)

Address(required)

City(required)

State(required)

Zip Code(required)

Telephone No.(required)

Alternate No.

Are you under 18 years of age?(required)

Yes

No

How long have you lived at above address?(required)

If hired, can you present proof of your legal right to work in the United States?(required)

Yes

No

Employment Desired

Position for which you are applying(required)

If more than one, list in order of preference.

Compensation Expected:(required)

Availability

Monday From:(required)

To:(required)

Tuesday From:(required)

To:(required)

Wednesday From:(required)

To:(required)

Thursday From:(required)

To:(required)

Friday From:(required)

To:(required)

Saturday From:(required)

To:(required)

Sunday From:(required)

To:(required)

If your application is considered favorably, on what date can you start work?(required)

Have you ever applied for a job with the company?(required)

Yes

No

If yes, where and when?(required)

Have you ever worked for the company before?(required)

Yes

No

If yes, where and when?(required)

How did you learn of this position?(required)

Education

High School(required)

Address(required)

Years Attended(required)

Degree(required)

Major(required)

College

Address

Years Attended

Degree

Major

Graduate

Address

Years Attended

Degree

Major

Other

Address

Years Attended

Degree

Major

Describe any professional, certifications or designations:

Describe any other special job-related skills or qualifications acquired from employment or other experience:

State any additional information you feel may be helpful to us in considering your application:

References

Please provide three references that meet the following criteria: not a relative, not a previous employer, and whom you have known at least one year.

Name(required)

Address(required)

Telephone(required)

Name(required)

Address(required)

Telephone(required)

Name(required)

Address(required)

Telephone(required)

Former Employers

Please list in order, current employer first. If you need additional space to complete, please continue on a separate sheet of paper.

Employer:

From:

To:

Address:

Pay From:

To:

Telephone:

Supervisor:

May we contact them?

Yes

No

Job Title/Duties

Exact Reason for Leaving

Employer:

From:

To:

Address:

Pay From:

To:

Telephone:

Supervisor:

May we contact them?

Yes

No

Job Title/Duties

Exact Reason for Leaving

Employer:

From:

To:

Address:

Pay From:

To:

Telephone:

Supervisor:

May we contact them?

Yes

No

Job Title/Duties

Exact Reason for Leaving

Employer:

From:

To:

Address:

Pay From:

To:

Telephone:

Supervisor:

May we contact them?

Yes

No

Job Title/Duties

Exact Reason for Leaving

Resume

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Maximum size 10MB

I certify that the information contained in this application is correct to the best of my knowledge, and understand that falsification of this application in any details is grounds for disqualification from further consideration or for dismissal from employment in accordance with company policy. I authorize Lueken's to verify the information company guidelines and rules of the company, including Lueken's Drug and Alcohol Policy. I understand that my employment and compensation can be terminated, with or without cause, and with or without notice, at any time, at the option of either the company or me. I further understand that no personnel recruiter or interviewer or other representative of the company, other than the President, has any authority to enter into any agreement for employment for any specified period of time.